Knox Blaine, Mitchell Scott, Hernly Ellen, Rose Alicia, Sheridan Hilary, Ellerbeck Edward F
University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, Kansas City, KS.
Kans J Med. 2017 Nov 30;10(4):1-11. eCollection 2017 Nov.
Smoking is the number one preventable cause of death in the United States. Under the Affordable Care Act, Kansas Medicaid covers all seven FDA-approved smoking cessation therapies. However, it is estimated only 3% of Kansas Medicaid smokers use treatment compared to the national estimate of 10%. The objective is to determine systemic barriers in place that prevent optimal utilization of Medicaid smoking cessation benefits among KU Medical Center Internal Medicine patients.
For this quality improvement project, a population of 169 Kansas Medicaid smokers was identified who had been seen at the KU Internal Medicine Clinic from January 1, 2015 - February 16, 2016. Phone surveys were completed with 62 individuals about smoking status, interest in using smoking cessation treatment options, and awareness of Medicaid coverage of treatment.
Of the 62 respondents, 24 (39%) were prescribed pharmacotherapy and 41 (66%) were interested in using smoking cessation treatment. There were eight who had quit smoking. Of the remaining 54 smokers, 31 (57%) were unaware that Medicaid would cover pharmacotherapy. Of 24 participants who received a prescription for pharmacotherapy, 13 (54%) were able to fill the prescription at no cost using the Medicaid benefit.
The majority of respondents were interested in using smoking cessation treatment yet three main barriers existed to using Medicaid smoking cessation benefits: physicians not prescribing treatment to patients, patients not aware of Medicaid coverage, and inadequate pharmacy filling. Improved physician and patient awareness of Medicaid coverage will facilitate more patients receiving smoking cessation therapy and ultimately quitting smoking.
吸烟是美国头号可预防的死因。根据《平价医疗法案》，堪萨斯州医疗补助计划涵盖了美国食品药品监督管理局（FDA）批准的所有七种戒烟疗法。然而，据估计，堪萨斯州医疗补助计划覆盖的吸烟者中只有3%使用了戒烟治疗，而全国估计比例为10%。目的是确定存在哪些系统性障碍，阻碍了堪萨斯大学医学中心内科患者对医疗补助计划戒烟福利的最佳利用。
对于这个质量改进项目，确定了169名堪萨斯州医疗补助计划覆盖的吸烟者，他们在2015年1月1日至2016年2月16日期间曾在堪萨斯大学内科诊所就诊。对62人进行了电话调查，询问他们的吸烟状况、使用戒烟治疗方案的意愿以及对医疗补助计划覆盖戒烟治疗的知晓情况。
在62名受访者中，24人（39%）被开具了药物治疗处方，41人（66%）有意愿使用戒烟治疗。有8人已经戒烟。在其余54名吸烟者中，31人（57%）不知道医疗补助计划会覆盖药物治疗。在24名接受药物治疗处方的参与者中，13人（54%）能够利用医疗补助福利免费配药。
大多数受访者有意愿使用戒烟治疗，但在利用医疗补助计划戒烟福利方面存在三个主要障碍：医生未给患者开治疗处方、患者不知道医疗补助计划的覆盖范围以及药房配药不足。提高医生和患者对医疗补助计划覆盖范围的知晓度将有助于更多患者接受戒烟治疗并最终戒烟。
